Pelvic Exam During Pregnancy – Is It Really Necessary?

During pregnancy, you’re likely to have a number of prenatal check ups with your care provider.

These check ups are to monitor your health and wellbeing, as well as to check on the growth and development of your baby.

Some doctors and midwives offer pelvic examinations as part of their prenatal care.

Although there are reasons why a vaginal examination might be necessary during pregnancy, it’s still an intervention, and every woman should know the risks and benefits before having one.

If you’ve talked to experienced mothers, you might assume prenatal vaginal exams are a normal and necessary part of care. While there are cases where vaginal exams can be helpful prior to labour, in a healthy term pregnancy they don’t usually provide any necessary information.

How Is A Pelvic Exam Performed?

When you have a pelvic examination, you remove your lower clothing and lie on the table. The care provider places a gloved index and middle finger into the vagina and assesses the cervix. This can feel uncomfortable, or even painful, and some women find the examination distressing.

The care provider feels how soft or ripe the cervix is, and whether there’s any thinning (effacement) or opening (dilation) of the cervix. The position of the cervix is also assessed – whether it’s posterior (facing toward the tailbone) or anterior (toward the front). Other details may be noted, such as how far into the pelvis the baby has descended, if at all, and which way the baby is facing (presentation).

Why Are Pelvic Exams Offered?

In most cases, an examination – to do a pap smear and other tests – will be performed early in pregnancy. If there are no complications during pregnancy, usually there will be no further exams until around 36 weeks. After this time, it’s common for practitioners (especially in the US) to do exams at every visit during the rest of the pregnancy. The rationale for this is to check for changes to the cervix and to determine whether labour is imminent.

Some practitioners want to do a vaginal examination at every prenatal visit during pregnancy. Unless there are compelling medical reasons, this isn’t necessary.

Medical Reasons For a Pelvic Exam During Pregnancy

History of infertility

Gynaecological problems

Painful intercourse

Suspicion of cervical problems, such as scarring or premature labour

The need to check how favourable cervix is, if induction is necessary.

Can A Pelvic Exam Indicate When I Will Go Into Labour?

One of the things an assessment of your cervix cannot do is determine the day and time you will go into labour. In fact, research has discovered there’s a particular substance, secreted by your baby’s lungs, which triggers labour. So your cervix is definitely not a good indicator of what might happen in the future.

A cervix that is soft and dilated today doesn’t suggest that tomorrow or the next day it will ripen or dilate more. Often pregnant women can be slightly dilated (1-2cms) for weeks before labour actually begins.

Cervical dilation is dependent on factors that are beyond our control. Many women experience a long prelabour and a fast active labour – where the early labour has done a lot of the work of ripening and softening the cervix, and dilation is fast. Other women might have many hours of labour before the cervix is dilated. A cervix that’s high, tight and closed one day might start to thin and dilate the next.

Are There Risks In Pelvic Exams?

Although the care provider is using a sterile glove, there’s a chance of bacteria from the vagina being pushed up into the cervix. This increases the risk of infection of the membranes of the amniotic sac, which is a serious complication.

There’s also the risk of stimulating the cervix and rupturing the membranes (PROM). If you are not due, or your baby is not ready to be born, this can lead to more interventions during labour, such as augmentation of contractions, continuous fetal monitoring, induction, or even c-section.

There are also psychological aspects of pelvic exams. Many women who are told they are so many centimetres dilated, with a soft, ripe cervix, expect to go into labour immediately. Yet days pass and they’re still pregnant. This expectancy and disappointment can lead them to give consent to, or request, an induction.

What If My Care Provider Tells Me I Must Have A Pelvic Exam?

If your care provider insists on a pelvic exam, it’s important to know why. Ask for the specific reason for the exam, what it aims to find out, and how it will alter anything for your pregnancy or birth.

If you aren’t convinced there’s a good reason for a pelvic exam, then you are within your rights to decline it, or to request a second opinion.

If you decide to go ahead with the exam, make sure your bladder is empty, and that you are warm, comfortable and properly covered. Your privacy must be ensured and no extra staff should be present unless you wish. Breathe deeply and relax your pelvic floor muscles to limit discomfort.

Having a pelvic examination during pregnancy should be something you decide only after having all the facts. You should understand why the exam is being suggested, what your care provider hopes to find out, and how this information will help. The procedure must be explained to you and your informed consent must be obtained.

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Sam McCulloch Dip CBEdCONTRIBUTOR

Sam McCulloch enjoyed talking so much about birth she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she writes . She is mother to three beautiful little humans.

I love this. My due date was yesterday and I have not had one internal exam because I haven’t felt that it was necessary and my midwives have agreed. I even did my Group Strep B test myself. I feel like I have the right to decline a procedure that feels invasive and distressing as well as unnecessary. I’m going to share this article because certain people in my boyfriend’s family have pretty much SHAMED ME for refusing these exams, telling me that my midwives are inadequate for not doing a routine exam and that “something is just not right about this.” I think that is ridiculous. It’s my body and if I don’t feel comfortable and if not doing it isn’t harming my baby, I will not do it.

Yes that’s fine, as long as she and the baby are healthy. A full term pregnancy is actually up to 42 weeks of pregnancy. The estimated due date is a guess in the middle – 40 weeks. Only 3-5% of babies are born on their estimated date. All the best!

Every procedure, including a pelvic exam, has both risks and benefits. Sometimes benefits obviously outweigh the risk, but in the case of routine pelvic exams, there is not a lot of evidence to suggest this. You should never just “do what your doctor says”. It is very likely that 2 doctors will have different opinions on this. You cannot be arrested for making a decision based on risk vs. benefit for your unborn child. That is your right as a patient.

Dont ever think this I was a patient and caught a dr smelling her fingers and felt disgusted on actually letting this doctor exam me at 6 months pregnant when in my previous 2 other childrens pregnancy i have never went through this. it was against my own judgement but BECAUSE they are doctors they are also PRacticing medicine so be ware and go on your own instincts that caused me humiliation and uncomfort i dont ever want anyone down there after this happened. No we have rights and informed consent my doctor has no reason to conduct this but cause they were a Doctor i trusted them. it was not needed to be done. I felt raped when i left especially after reading this article I knew i had rights.

How often during pregnancy should I receive pelvic exams? I had my first one ever today I’m 4 months pregnant and I was so uncomfortable I still don’t want my husband touching me. I feel completely violated and wasn’t prepared for the exam because I was unaware of what my appointment consisted of. I need to know if this will be necessary again.

I am 36weeks plus now and never went through any pelvic assessment so far. My dr has called me on week 38 for pelvic assessment as my baby’s position is occipito posterior so that she could know the exact position then and can decide about my delivery (either vaginal or cesarian)

My doctor told me today that she couldnt examin my pelvic because of my attitude towards it. She put her fingers in my vagina and i couldnt weaken, so after some seconds she stopped the procedure. I am almost 41weeks. She gave me 3days, or labour begins or c section will be nesessary. Also she asked me two times if i really was ready for natural labour. I am ready, i dont want c section, but it is up to my baby and my body. I cant understand how she could not check my pelvic. Is it possible that i have any problem or what can be wrong?

I’m 34 weeks pregnant now and my doctor says at my next appointment, I’m going to have a pelvic examination. He says it’s to determine a couple of factors concerning delivery so we can discuss all my birthing options based on the results from the exam. I feel like his explanation was reasonable enough, but I’m still so squirmish about it….any advice?

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